Exam 2 - Cephalosporin & Carbapenem Spectrum of Activity/Clinical Uses Flashcards
Spectrum of 1st gen cephalosporins
Excellent GP coverage
(MSSA and PSSP)
Limited GN (PEK)
spectrum of 2nd gen cephalosporins
Same GP as 1st gen (MSSA and PSSP)
Some GN (HENPEK)
Some anaerobes
what 2nd gen cephalosporins cover below the diaphragm anaerobes (BDA)
cefoxitin, cefotetan, cefmetazole
includes Bacteroides fragilis coverage
spectrum of 3rd gen cephalosporins
GP aerobes (PRSP + PSSP + MSSA only ceftriaxone and cefotaxime)
GN aerobes (HENPECKSSS and Pseudomonas aeruginosa)
Limited anaerobes
what third gen cephalosporins cover pseudomonas aeruginosa?
ONLY ceftazidime and cefoperazone
what 3rd gen cephalosporins are strong inducers of BLases (Class C or AmpC)
ceftazidime
spectrum of 4th gen cephalosporins
GP (PSSP, PRSP, MSSA)
GN (Pseudomonas aeruginosa, BLase producing Enterobacter and E. Coli)
do 4th gen cephalosporins induce BLases?
Poor inducers of type1/AmpC
Spectrum of Ceftaroline
GP (PSSP, PRSP and MSSA, MRSA)
GN (HENPECKSSS and no pseudomonas)
spectrum of cefiderocal
GP: none
GN: enterobacterales, P. aeruginosa, ESBLs, AmpCs, and carbapenamases (KPCs)
spectrum of ceftolozane-tazobactam (Zerbaxa)
GP: very little
GN: Pseudomonas Aeruginosa, ESBLs, HENPECKSSS
spectrum of ceftazidime-avibactam
GP: little to none
GP: ESBLs, AmpC enterbacterales, Pseudomonas aeruginosa
what is the “weakness” of cephalosporins when it comes to coverage?
no enterococcus coverage
clinical uses of 1st gen cephalosporins
skin and soft tissue infections of MSSA and streptococci
what is the drug of choice for surgical prophylaxis against surgical site infections
Cefazolin
should 1st cephalosporins be used for meningitis?
NO, cant access CNS
clinical uses of 2nd gen cephalosporins
pharyngitis, tonsillitis, sinusitis, otitis media, bronchitis, community acquired pneumonia
can you use cefuroxime for meningitis?
NO
what 2nd gens are good for bacteroides fragilis, surgery prophylaxis in abdomin/pelvic, and polymicrobial infections?
cephamycins, cefoxitin, cefotetan, cefmetazole
clinical uses of 3rd gen cephalosporins
infections caused by GN bacteria (including nosocomial) and pseudomonas aeruginosa
if pseudomonas aeruginosa is suspected what 3rd gens should be used?
ceftazidime or cefoperazone
what 3rd gen is used for uncomplicated gonorrhea
single IM of ceftriaxone
what 3rd gens should be used for PRSP
cefotaxime and ceftriaxone
what is cefepime used for
antipseudomonal activity
what can ceftaroline treat
skin and soft tissue infections (including thos caused by MRSA and CABP
why is cefiderocol not used more
very expensive and IV only
what is the GP coverage of carbapanems
PSSP and MSSA
imipenem and doripenem the best
what is the gram negative coverage for carbapenems
DRUG OF CHOICE for ESBL and AmpC producing bacteria (dori and mero the best)
pseudomonas aeruginosa
what carbapenem does NOT cover pseudomonas aeruginosa
ertapenem
do carbapenems cover c. diff
NO
what GN anaerobes do carbapenems cover
bacteroides spp.
when are carbapenems typically used
polymicrobial infections, empiric for nosocomial infections, and infections due to GN resistant bacteria especially ESBLs or AmpCs
what is the spectrum coverage for monobactams
GN aerobes (pseudomonas aeruginosa)
when is monbactams (aztreonam) particularly useful?
treating GN infections in patients w/ a histroy of severe penicillin or B-lactam allergy
